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Diagnosis and Management of Osteoarticular Tuberculosis: A Drastic Change in Mind Set Needed—It is Not Enough to Simply Diagnose TB

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

In the era of increasing drug resistance in pulmonary tuberculosis (TB), it is prudent to assess causes of poor response to anti tubercular therapy (ATT) and drug sensitivity pattern (DSP) in osteoarticular TB.

Materials and Methods

As a part of Bombay Orthopaedic society’s research project, members were asked to refer non responders to ATT to our institute. Cases were enrolled from October 2010 to March 2014. Deep tissue samples were obtained in all but five cases and subjected to a battery of tests including histopathology (HPE) and TB culture and sensitivity. The DSP was compared with the study performed by the principle author from 2004 to 2007 and published in 2009.

Results

39 male and 50 female patients with a mean age of 24.85 years (2–66) were included and classified in four groups after results. (1) Culture and HPE positive-36. 24 had MDR and three XDR TB. Primary resistance to even second line drugs and deterioration of DSP since last study was noted, (2) culture negative and HPE positive-21. The cause of poor response was surgical in more than half cases, (3) non representative samples or lost to follow-up-15, (4) TB mimics-16.

Conclusion

There is increasing incidence of primary resistance to second line drugs, primary resistance in children and worsening of resistance patterns as compared to older studies. ATT initiation is a fateful decision and every attempt should be made to rule out TB mimics and establish DSP before initiation.

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Acknowledgements

The authors would like to acknowledge the Bombay Orthopaedic Society (BOS) and a senior Orthopaedic surgeon (who wishes to remain unnamed) for their generous financial contribution for this project.

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Authors and Affiliations

  1. Department of Orthopaedics, P D Hinduja National Hospital and MRC, Mahim, Mumbai, Maharashtra, India

    Vikas M. Agashe, Jitendra Pingle, Mandar Agashe, Hitendra Patil, Sagar Raghuwanshi, Manit Gundavda, Raju Gite, Mithun Jakkan, Amit Mishra & Aditya Menon

  2. Agashe Maternity and Surgical Nursing Home, Kurla, Mumbai, Maharashtra, India

    Vikas M. Agashe

  3. Department of Microbiology, P D Hinduja Hospital and MRC, Mahim, Mumbai, Maharashtra, India

    Camilla Rodrigues, Anjali Shetty & Kanchan Ajbani

  4. Infectious Disease Specialist, Department of Internal Medicine, P D Hinduja Hospital and MRC, Mahim, Mumbai, Maharashtra, India

    Rajiv Soman

  5. Department of Pathology, P D Hinduja Hospital and MRC, Mahim, Mumbai, Maharashtra, India

    R. B. Deshpande

Authors
  1. Vikas M. Agashe
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  2. Camilla Rodrigues
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  3. Rajiv Soman
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  4. Anjali Shetty
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  5. R. B. Deshpande
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  6. Kanchan Ajbani
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  7. Jitendra Pingle
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  8. Mandar Agashe
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  9. Hitendra Patil
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  10. Sagar Raghuwanshi
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  11. Manit Gundavda
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  12. Raju Gite
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  13. Mithun Jakkan
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  14. Amit Mishra
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  15. Aditya Menon
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Contributions

All authors have contributed to the study conception, design, methodology, material preparation, data collection, formal analysis and investigations. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vikas M. Agashe.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by the any of the authors.

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Agashe, V.M., Rodrigues, C., Soman, R. et al. Diagnosis and Management of Osteoarticular Tuberculosis: A Drastic Change in Mind Set Needed—It is Not Enough to Simply Diagnose TB. JOIO 54 (Suppl 1), 60–70 (2020). https://doi.org/10.1007/s43465-020-00202-7

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  • DOI: https://doi.org/10.1007/s43465-020-00202-7

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